Case report: Real-time contrast-enhanced ultrasonography for the diagnosis of typical 'bull's eye' sign of hepatic abscess caused by Acinetobacter baumannii in a tumor patient

Sonographic Detection of Hepatic Abscesses

Hepatic abscesses are masses or lesions within the liver as a response to an infection manifesting into the liver. Hepatic abscess can be a result of other abdominal diseases, such as any biliary tract disease or appendicitis. Because of its inconsistent characteristics in many imaging modalities, its appearance can be mistaken for other pathologies like liver metastasis. With the use of one or more imaging modalities and an imaging-guided biopsy of the targeted lesion, hepatic abscess can be confirmed. The case presents multiple hepatic abscesses throughout the liver with similar imaging characteristics as that of metastasis. Computed tomography (CT), sonography, magnetic resonance imaging, and a biopsy were performed to successfully diagnose the hepatic abscesses.

Ultrasound and contrast-enhanced ultrasound (CEUS) in infective liver lesions

Infektiöse fokale Leberläsionen (FLL) treten in der klinischen Praxis häufig auf, wobei bakterielle Leberabszesse die Hälfte ausmachen. Eine genaue Diagnose der FLL ist für die Auswahl der am besten geeigneten Therapie und zur Vorbeugung von Komplikationen unerlässlich. Ziel der aktuellen Arbeit ist es, den Nutzen von Ultraschall und kontrastmittelverstärktem Ultraschall (CEUS) zur Erkennung und Charakterisierung infektiöser Leberläsionen zu beschreiben.

Successful Diagnosis of a Longstanding Giant Amoebic Liver Abscess Using Contrast-Enhanced Ultrasonography (CEUS): A Case Report in a Western Country

BACKGROUND E. histolytica liver abscess results from extra-intestinal diffusion of amebiasis, which is responsible for up 100 000 deaths per annum, placing it second only to malaria in mortality. Currently, the criterion standard for the diagnosis of liver abscesses is ultrasound, but CEUS (contrast-enhanced ultrasound) is emerging as a more accurate method for liver study, and it could be more accurate than ultrasound and non-invasive compared to CT. CASE REPORT A white man (59 years old) with a 2-day history of dyspnea, acute abdominal pain in right upper quadrant, and raised inflammatory markers was admitted to a second-level Emergency Department in Rome (Italy). He reported several trips to tropical areas many years before, during which he ingested non-potable water and became infected with Entamoeba histolytica. This was treated medically with success. After administration of antibiotics (meropenem and metronidazole), a liver CEUS (contrast-enhanced ultrasonography) with administration of SonoVue (sulphur hexafluoride microbubbles) confirmed a giant liver abscess (15×16 cm). One day later, CT-guided drainage was performed without complications and the patient was discharged on the 25th post-procedure day, with improved blood results. CONCLUSIONS Acute abdominal pain can be caused by a variety of diseases, but a diagnosis of parasitic abscess should not be overlooked in non-endemic Western countries. CEUS is a new, promising, and more accurate technique that can be utilized to recognize liver abnormalities, including abscesses; however, retrospective population-wide studies are necessary to define the differential diagnoses.